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Allergies
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Annual Physical
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Anxiety
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Blood Pressure
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Congestion
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Cough
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Depression
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Diarrhea
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Hormones
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Lab Results
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Nausea
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Pain
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Medication Refill(s)
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Swelling
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Vomiting
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Primary Problem Today
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Where is the problem?
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What caused this problem?
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The problem is worse when...
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For about how long?
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Timing of main problem
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The problem is better when...
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List related symptoms
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Tobacco User?
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Alcohol User?
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Illicit Drug User?
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New Field
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Experienced in last 3 mo - Const
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Experienced in last 3 mo - Neuro
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Experienced in last 3 mo - Head
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Experienced in last 3 mo - Eye
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Experienced in last 3 mo - Skin
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Experienced in last 3 mo - Msk
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Experienced in last 3 mo - G.I.
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Exp. in last 3 mo - Respiratory
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Exper. in last 3 mo - Cardio
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Exp. in last 3 mo - Genito/Uri
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Exp. in last 3 mo - Endocrine
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Exp. in last 3 mo - Psych
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Exp. in last 3 mo - Allergy
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Family History - Mother
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Family History - Father
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Family History - Sibling 1
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Family History - Sibling 2
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Family History (free text)
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Family History (free text)
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Active Condition 1
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Surgery 1
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Active Condition 2
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Surgery 2
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Active Condition 3
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Surgery 3
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Active Medication 1
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Active Medication 2
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Active Medication 3
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Active Medication 4
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